Laboratory Studies

Laboratory studies are directed at elucidating the severity of illness as well as the etiology of the infection. Mild cases of mastitis usually do not require laboratory investigation. Wound infections and infections of the genital tract makes it more difficult to ascertain the extent of involvement.

Laboratory studies should include the following:

Complete blood count
Electrolytes
Blood cultures, if sepsis is suspected
Urinalysis, with cultures and sensitivity tests
Cervical or uterine cultures
Wound cultures, if appropriate
Lactate, if sepsis suspected
Coagulation studies, if pelvic thrombosis, deep vein thrombosis, pulmonary embolism, or invasive treatment (eg, surgical procedure) is being considered

Imaging Studies

Pelvic ultrasonography may be helpful in detecting retained products of conception, pelvic abscess, or infected hematoma.

Contrast-enhanced CT or MRI are useful in establishing the diagnosis of septic pelvic thrombosis.^[12]

In some cases, a contrast-enhanced CT examination of the abdomen and pelvis may be helpful if concurrent concern is present for other non-pregnancy–related abdominal/pelvic sources of the infection (eg, appendicitis, colitis).

Treatment & Management

Cunningham GF, Levano KJ, Gilstrap LC, et al. Puerperal Infection. Cunningham GF, Levano KJ, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2005. 711-24.
Yokoe DS, Christiansen CL, Johnson R, Sandu KE, et al. Epidemiology of and Surveillance for Postpartum Infectious. Emerg Infect Dis. Sep-Oct 2001. 7(5):837-41. [QxMD MEDLINE Link]. [Full Text].
Adair FL. The American Committee of Maternal Welfare, Inc: The Chairman's Address. Am J Obstet Gynecol. 1935. 30:868.
Haas DM, Morgan S, Contreras K, Enders S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2018 Jul 17. 7:CD007892. [QxMD MEDLINE Link].
Monif GR, Baker DA. Infectious Diseases in Obstetrics and Gynecology. 6th ed. Informa HealthCare; 2008.
Atterbury JL, Groome LJ, Baker SL, Ross EL, Hoff C. Hospital readmission for postpartum endometritis. J Matern Fetal Med. 1998 Sep-Oct. 7(5):250-4. [QxMD MEDLINE Link].
Newton ER, Prihoda TJ, Gibbs RS. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet Gynecol. 1990 Mar. 75(3 Pt 1):402-6. [QxMD MEDLINE Link].
Maharaj D. Puerperal Pyrexia: a review. Part II. Obstet Gynecol Surv. 2007 Jun. 62(6):400-6. [QxMD MEDLINE Link].
Bauer ME, Bateman BT, Bauer ST, et al. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. 2013 Oct. 117(4):944-50. [QxMD MEDLINE Link].
Schwartz MA, Wang CC, Eckert LO, Critchlow CW. Risk factors for urinary tract infection in the postpartum period. Am J Obstet Gynecol. 1999 Sep. 181(3):547-53. [QxMD MEDLINE Link].
Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003 Feb 21. 52(2):1-8. [QxMD MEDLINE Link].
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French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. Oct 2004. 18(4):CD001067. [QxMD MEDLINE Link].
Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015 Feb 2. 2:CD001067. [QxMD MEDLINE Link].
Amir LH, Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med. 2014 Jun. 9 (5):239-43. [QxMD MEDLINE Link].
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Author

Andy W Wong, MD Resident Physician, Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital

Andy W Wong, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark L Zwanger, MD, MBA, FACEP Emergency Medicine Physician

Mark L Zwanger, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Bruce M Lo, MD, MBA, RDMS, FACEP, FAAEM, FACHE, FAAPL, CPE Chief, Department of Emergency Medicine, Sentara Norfolk General Hospital; Medical Director, Sentara Transfer Center; Professor and Assistant Program Director, Core Academic Faculty, Department of Emergency Medicine, Eastern Virginia Medical School; Board Member, American Academy of Emergency Medicine

Bruce M Lo, MD, MBA, RDMS, FACEP, FAAEM, FACHE, FAAPL, CPE is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership, American College of Emergency Physicians, American College of Healthcare Executives, American Institute of Ultrasound in Medicine, Emergency Nurses Association, Medical Society of Virginia

Disclosure: Nothing to disclose.

Additional Contributors

Assaad J Sayah, MD, FACEP President and Chief Executive Officer, Cambridge Health Alliance

Assaad J Sayah, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Elicia Kennedy, MD Clinical Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences.

Elicia Kennedy is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine.

Disclosure: Nothing to disclose.

Andy W Wong, MD Resident Physician, Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital

Andy W Wong, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Postpartum Infections Workup

Laboratory Studies

Imaging Studies

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